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NPI Code Detail

MEDICARE: EMMA LARSEN

MEDICARE: EMMA LARSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-23-293115IL

General Provider Information

NPI Number : 1811772148
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMA LARSEN
Provider Business Mailing Address
First Line : 2650 N LAKEVIEW AVE APT 1405
Second Line :
City : CHICAGO
State : IL
Zip : 60614-2950
Country : US
Telephone Number : 952-797-3766
Fax Number :
Provider Business Practice Location Address
First Line : 332 S MICHIGAN AVE STE 900
Second Line :
City : CHICAGO
State : IL
Zip : 60604-4393
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2023
Last Update Date : 08/25/2023

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Directions to “ EMMA LARSEN ” Practice Location

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